Evidence-Based Medicine

Last update: 30 September 2009,
by Maureen Bell

I have made some notes which I use in my Cochrane Library demonstration sessions. They contain background material, links and references on evidence-based medicine, and the Cochrane Collaboration.You can Click here to view them.

I've divided this page into two sections. The first provides you with some tips on searching for material on Medline, and the second provides links to other Australian and overseas web resources, including some full text material.

Searching for Evidence-Based Medicine on Medline

CLINICAL TRIAL PHASE III
CLINICAL TRIAL PHASE IV
Both of these experimental designs use a control group, as does

CONTROLLED CLINICAL TRIAL

META ANALYSIS
is a statistical analysis that allows the results of several studies to be pooled to provide more reliable EBP data.

PRACTICE GUIDELINE
Should be a list of evidence based serial statements to assist in diagnosis and treatment of particular conditions.

RANDOMIZED CONTROLLED TRIAL
This is the gold standard for Evidence Based Practice.

PubMed also has a special feature PubMed Clinical Queries a specialised search, intended for clinicians, which has built-in search "filters" for detecting clinically sound studies in Medline. Four study categories--therapy, diagnosis, etiology, prognosis--are provided, and you can choose the emphasis to be either specificity (i.e., mostly relevant articles but probably omiting a few) or sensitivity (i.e., most relevant articles but probably some less relevant ones). For details see the PubMed Clinical Queries Filter Table which explains sensitive (broad) and specific (narrow) searches and approximate equivalents in the PubMed query language as recommended in
Developing optimal search strategies for detecting clinically sound studies in MEDLINE.
Haynes et al. J Am Med Inform Assoc.1994 November;1 (6): 447–458.

There is also a Systematic Reviews Subset Strategy which can be appended to any search..

For step-by-step notes on searching PubMed for evidence based practice click here

PICO Model

Construct Well-Built Clinical Questions using PICO
From the University of Washington HealthLinks.

PICO - Asking Focused Questions
From the Centre for Evidence Based Medicine

Using PICO to help define the problem
Using PICO in a public health context.

Other Resources

ARIF Critical Appraisal Process
From the Aggressive Research Intelligence Facility based at the University of Birmingham, set up to help health care workers access and interpret research evidence in response to particular problems, the ARIF critical appraisal process is described here, and linked to this page are details about the purpose of critically appraising review articles and the checklist ARIF uses formally to do this.

Bandolier
The first issue of Bandolier, an independent journal about evidence-based healthcare, written by Oxford scientists, was printed in February 1994. Originally published monthly, it is now updated infrequently.

The Campbell Collaboration
The Campbell Collaboration collaborates closely with its sibling organization, the Cochrane Collaboration, which prepares and maintains systematic reviews of the effects of interventions in health care. The Campbell Library of Systematic Reviews provides free online access to systematic reviews in the areas of education, criminal justice and social welfare.

CASP (Critical Appraisal Skills Programme)
The Critical Appraisal Skills Programme is part of the Public Health Resource Unit, working at the Institute of Health Sciences in Oxford, to help bring the principles and practice of evidence-based practice to as wide an audience as possible.

CenterWatch Clinical Trials Listings
CenterWatch Inc. is a multimedia publishing company based in Boston, Massachusetts. The web site is designed to be a resource both for patients interested in participating in clinical trials and for research professionals.

Centres for Health Evidence (CHE). Users' Guides to Evidence-Based Practice
A complete set of Users' Guides originally published in the Journal of the American Medical Association (JAMA). The full text is available here in its pre-publication version with permission from the journal.

ClinicalTrials.gov: Linking Patients to Medical Research
The U.S. National Institutes of Health, through its National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members and members of the public with current information about clinical research studies.

CONSORT (CONsolidated Standards of Reporting Trials) Statement
The CONSORT Statement is intended to improve the reporting of a randomized controlled trial (RCT), enabling readers to understand a trial's design, conduct, analysis and interpretation, and to assess the validity of its results

EBM Tools
From the Centre for Evidence-Based Medicine situated at Oxford University.

eMJA: Clinical Guidelines
Clinical guidelines from the Medical Journal of Australia - listed by topic.

EPC Evidence Reports
Under the Evidence-based Practice Program of the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research—AHCPR), 5-year contracts are awarded to institutions in the United States and Canada to serve as Evidence-based Practice Centers (EPCs). The EPCs review all relevant scientific literature on clinical, behavioral, and organization and financing topics to produce evidence reports and technology assessments.

Evidence-Based Decisionmaking for Community Health Programs
By Catherine A. Jackson, Kathryn Pitkin, and Raynard Kington. A RAND research document, MR-933-MLHS, 1998.

Evidence-Based Medicine Glossary
From the Centre for Evidence-Based Medicine situated at Oxford University.

Evidence-Based Medicine Resource Center
Formed by the New York Academy of Medicine in partnership with the Evidence-based Medicine Committee of the American College of Physicians, New York Chapter.

Evidence Based Medicine Tool Kit
From the University of Alberta.

Evidence-Based Medicine: What it is and what it isn't
An editorial by David L Sackett and others, from the BMJ 13th January 1996 (BMJ 1996; 312: 71-2)

Health Evidence Network (HEN)
HEN is a programme of the World Health Organization Regional Office for Europe. Of particular interest are the Evidence Reports, the full text of which is available on line.

Health Report - Facing the evidence - part one
Health Report - Facing the evidence - part two
Transcripts from Radio National's Health Report, with Norman Swan.

Health Technology Assessment (HTA) Database
Health care technology is defined as prevention and rehabilitation, vaccines, pharmaceuticals, and devices, medical and surgical procedures, and the systems within which health is protected and maintained. Technology assessment studies the medical, social, ethical and economic implications of development, diffusion, and the use of health technology and informs policy decisions. Its aim is to improve the quality and cost-effectiveness of healthcare.

HealthLinks: Evidence-Based Practice
A useful selection of links from the University of Washington.

Introduction to Evidence-Based Medicine
This is a helpful tutorial from the Duke University Medical Center Library. Check the section entitled The Well-Built Clinical Question", and the section on "The Literature Search" is also worth looking at for its PubMed search example.

Locating and Appraising Systematic Reviews
This article from the journal Annals of Internal Medicine (April 1997) looks at the ways of locating systematic reviews, covering their strengths and weaknesses. The methods of finding these reviews include electronic databases such as MEDLINE, Best Evidence and the Cochrane Library. It also present steps used to critically appraise review articles. The article is provided by the American College of Physicians for medical professionals.

National Guideline Clearinghouse
The National Guideline Clearinghouse™ (NGC) is a comprehensive database of evidence-based clinical practice guidelines and related documents produced by the Agency for Health Care Policy and Research (AHCPR), in partnership with the American Medical Association (AMA) and the American Association of Health Plans (AAHP).

National Health and Medical Research Council - NHMRC - Clinical Practice Guidelines

National Health and Medical Research Council. Handbook series on preparing clinical practice guidelines
This series includes a number of titles, including:-

How to review the evidence: systematic identification and review of the scientific literature.
How to use the evidence: assessment and application of scientific evidence.
How to put the evidence into practice: implementation and dissemination strategies.
How to present the evidence for consumers: preparation of consumer publications.
How to compare the costs and benefits: evaluation of the economic evidence

National Quality Measures Clearinghouse (NQMC)
NQMC is sponsored by the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. It is a public repository for evidence-based quality measures and measure sets.

Netting the Evidence : A ScHARR Introduction
An evidence-based search site maintained by the School of Health and Related Research at the University of Sheffield. You will find a wealth of material at this site as well as links to further resources.

New Zealand Health Technology Assessment ( NZHTA) Publications
New Zealand Health Technology Assessment (NZHTA) was a clearing house for health outcomes and health technology assessment, operating from 1997-June 2007. NZHTA is no longer active but publications can still be accessed from this list.

NICE (National Institute for Health and Clinical Excellence)
NICE is part of the National Health Service (NHS), and its role is to provide patients, health professionals and the public with authoritative, robust and reliable guidance on current “best practice”.

NICHSR (National Information Center on Health Services Research & Health Care Technology) Introduction to HSR (Health Services Research) Class Manual: Evaluating the Literature
A straightforward training manual on Evaluating the Literature: Quality Filtering and Evidence-Based Medicine and Health, from the National Library of Medicine.

NLH - National Library of Guidelines
The National Library of Guidelines is a collection of guidelines for the NHS. It is based on the guidelines produced by NICE and other national agencies. The main focus of the Library is on guidelines produced in the UK, but where no UK guideline is available, guidelines from other countries are included in the collection.

The Relation Between Systematic Reviews and Practice Guidelines
This article from the journal Annals of Internal Medicine (August 1997) looks at the distinction between a systematic review and a practice guideline. It covers methods of developing guidelines, the role of evidence in the development of guidelines, how to use systematic reviews to build guidelines and clinical pathways, and the limitations of relying on the reviews. The site is provided by the American College of Physicians.

A Schema for Evaluating Evidence on Public Health Interventions
A paper prepared by Lucie Rychetnik and Michael Frommer for the National Public Health Partnership. Version 4 April 2002.

Scottish Intercollegiate Guidelines Network (SIGN)
The Scottish Intercollegiate Guidelines Network (SIGN) was formed in 1993. Their objective is to improve the quality of health care for patients in Scotland, through the development and dissemination of national clinical guidelines containing recommendations for effective practice based on current evidence.

SUMSearch
SUMSearch is new method of searching the Internet for evidence based medical information. Querying a number of key databases, such as MEDLINE, and the Database of Abstracts of Reviews of Effects (DARE ), SUMSearch aims to select the most appropriate source, format the search query, modify this query if too few or too many hits are found, and return a single document to the clinician.

SUNY Health Sciences Evidence Based Medicine Tutorial
From the State University of New York. (The guides to searching, and the examples are applicable only to the OVID(tm) character-based version of Medline.)

TRIP Database
The TRIP Database searches across 58 sites of high-quality medical information and gives direct, hyperlinked access to 'evidence-based' material on the web as well as articles from premier on-line journals such as the BMJ, JAMA, NEJM etc.

Undertaking Systematic Reviews of Research on Effectiveness (CRD Report no. 4)
First published on 4 January 1996, this CRD Report contains Guidelines developed and published by the NHS Centre for Reviews and Dissemination, which can be used as a framework for carrying out systematic reviews or used for information by organisations commissioning reviews.